Our Units

National Influenza Center

Introduction:

National Influenza Centre is one of the newly established and highly equipped departments of National Public Health Laboratory (NPHL) designated by Ministry of Health and Population (MoHP) and recognized by World Health Organization (WHO) for the purpose of participating in WHO Global Influenza Programme. Upon such recognition by WHO, NIC become member of the WHO Global Influenza Surveillance Network.

Influenza Surveillance started since 2004 from Jhapa, eastern part of Nepal with the aim to identify the influenza viruses from suspected cases of influenza like illness (ILI) and immediate response to minimize the circulation of viruses during outbreak. Initially, specimens collected from suspected cases of ILI were performed by Rapid Diagnostic Test (RDT) for identification of influenza viruses. Later on, molecular diagnostic assay based influenza surveillance was started with the introduction of Real-Time PCR (RT-PCR) at National Public Health Laboratory (NPHL) from 2009. During pandemic influenza outbreak in 2009, NPHL had played a key crucial role together with Epidemiology and Disease Control Division (EDCD), Department of Health Services including international organizations (WHO, WARUN). NPHL has been designated as National Influenza Centre (NIC) on 19th April, 2010. Influenza virus isolation, identification and characterization by serological molecular diagnostic assay were successfully started within one year and 28 isolates were shipped to WHO Collaborating Centre

(WHOCC) Japan on 27th November, 2011.

Terms of References (TORs):

General:

Serve as the key point of contact between the World Health Organization and the country of origin for virological and epidemiological Surveillance of influenza and provision of influenza virus isolates to the WHO Global Influenza Surveillance Network. Maintain active Communication with the members of the WHO Global Influenza Suveillance Network.

Virus isolation and Shipment:

Collect appropriate clinical specimens from patients throughout each year and especially during the influenza Season and outbreaks for the isolation of influenza virus. Undertake initial identification of virus type and subtype. Forward representative virus isolates and any low reacting viruses using the WHO reagents kit provided through the WHO network to a WHO Collaborating Centre for Reference and Research on Influenza within a defined period. Alert the WHO Global Influenza Programme on any influenza isolate that cannot be readily identified using reagents provided through the WHO network and immediately forward the isolate to a WHO Collaborating Centre for Reference and Research on Influenza.

Communication and Information-sharing:

Alert WHO and/or any of the WHO Collaborating Centers immediately on the emergence of outbreaks of influenza viruses that cannot be readily identified with the reagents in the WHO kit, or other indications of the emergence of influenza viruses with pandemic potential. Report regularly during the influenza season preferably weekly by electronic means on the extent of national influenza activity and intensity of virological surveillance and ensure timely distribution of this information at relevant national and international levels through for example WHO FluNet. Provide to the WHO Global Influenza Programme an annual national Summary on influenza activity, virological surveillance and other relevant information on the influenza epidemiological situation.

National influenza Surveillance Network (NISN):

Sentinel sites of NISN have been selected on the basis of region, geographical situation, human population density and possible epidemic prone areas of country for provision of representative influenza samples throughout the nation to NIC. The ten NISN sentinel sites are:

Eastern Region:

Mechi Zonal Hospital, Bhadrapur

BPKIHS, Dharan

Central Region:

Kanti Children Hospital, Kathmandu

Shukra Raj Tropical Hospital, Kathmandu

Chitwan District Hospital, Bharatpur

Western Region:

Western Regional Hospital, Pokhara

Lumbini Zonal Hospital

Palpa Mission Hospital

Mid-Western Region:

Nepalgunj Medical College, Banke

Far-Western Region:

Seti Zonal Hospital, Dhangadhi

These sentinel sites collect samples from suspected patients meeting case definition of Influenza like ilIness (ILI) and Severe Acute Respiratory Infection (SARI) for virus identification and isolation. Participating hospital laboratory perform rapid test and give immediate feedback to clinicians and dispatch samples collected in viral transport media (WTM) to NPHL maintaining cold chain within 48 hours of Collection. Patan Academy of Health Sciences (PAHS) and Walter Reed AFRIMS Research Unit Nepal (WARUN) are collaborating partners for active support during influenza season and sharing of specimen with NIC, International organization such as WHO and WHO-IPO has been supporting in various aspects during influenza outbreak and specimen transportation from sentinel sites of NISN.